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Schizophr Res. 2018 Dec;202:80-85. doi: 10.1016/j.schres.2018.06.042. Epub 2018 Jun 27.

Self-esteem moderates affective and psychotic responses to social stress in psychosis: A virtual reality study.

Author information

1
VU University and Amsterdam Public Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands. Electronic address: a.jongeneel@parnassiagroep.nl.
2
VU University and Amsterdam Public Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands; Arkin Mental Health Care Institute, Amsterdam, the Netherlands.
3
Parnassia Psychiatric Institute, The Hague, the Netherlands.
4
VU University and Amsterdam Public Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands.
5
University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.

Abstract

BACKGROUND:

Higher liability to psychosis is associated with low self-esteem and increased sensitivity to social stress. Recently, we reported a positive relation between liability to psychosis and affective and psychotic responses to social stress. This study investigated how self-esteem moderates paranoia, peak subjective distress and stress reactivity of people with different psychosis liability in response to social stressors in virtual reality.

METHODS:

Ninety-four individuals with lower (41 siblings and 53 controls) and 75 persons with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) explored five times a virtual café with various social stressors (crowdedness, ethnic minority status, and hostility). They rated momentary paranoia (State Social Paranoia Scale) after each experiment and subjective distress on a visual analogue scale before and after the experiments. Positive and negative self-esteem were assessed with the Self-Esteem Rating Scale.

RESULTS:

Momentary paranoia, peak subjective distress, and reactivity to social stressors were associated with negative self-esteem, but not positive self-esteem. Effects of both positive and negative self-esteem on psychotic and affective stress responses, but not stress reactivity, became significantly stronger when individuals were exposed to more stressful environments. Effects of self-esteem on momentary paranoia and peak subjective distress did not differ between the high liability and low liability group. Persons with lower psychosis liability had a stronger effect of negative self-esteem on stress reactivity than persons with higher liability.

CONCLUSIONS:

Positive and negative self-esteem may play an important role in affective and psychotic responses to social stress.

KEYWORDS:

First episode; Psychoses; Risk factors; Schizophrenia; Social phobia

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